摘要
背景:关节周围骨折复位后常出现骨缺损,需进行植骨填充骨缺损以早期支撑关节面以防止关节面塌陷及移位。同种异体骨是治疗骨缺损的移植材料,但成骨能力差。自体红骨髓有成骨能力,但同种异体骨复合自体红骨髓移植治疗关节周围骨折的临床效果有待评定。目的:采用锁定板固定、同种异体骨复合自体红骨髓移植治疗关节周围骨折的临床效果。方法:纳入河北医科大学第三医院骨伤科治疗关节周围骨折患者43例。采用切开解剖复位关节面、将红骨髓与同种异体骨颗粒复合体植于骨缺损处,植骨完成后常规解剖锁定板内固定。胫骨平台骨折采用内侧、外侧或双侧锁定板固定。桡骨远端骨折采用背侧或掌侧锁定板固定,胫骨远端骨折采用胫骨远端内侧或外侧板锁定内固定。结果与结论:患者43例共随访12个月至6年,平均4.3年。X射线片及CT复查结果显示,43例患者达骨性愈合,塌陷骨折复位良好。其中新鲜骨折愈合时间2-6个月,平均4个月;陈旧骨折愈合时间3-7个月,平均5.5个月。植骨后43例患者无明显免疫排斥反应,2例患者切口渗液较多,经换药2周愈合。切口感染患者1例,经引流换药4周伤口愈合,随访4年1个月至今感染未复发。根据Mankin和Komender标准评定,同种骨移植满意患者40例,占93%;不满意患者3例,占7%。结果证实,在锁定板支撑固定下,异体松质骨与自体红骨髓复合体移植治疗周围关节骨折可以起到近期支撑作用,防止关节面塌陷及骨折移位,并为关节周围骨折骨缺损提供骨重建材料,远期可以达到骨折愈合的目的。
BACKGROUND： Bone defects often occur after the reduction of periarticuar fractures, and bone grafting is required to fill bone defects, thereby to make the early support of articular surface and prevent the collapse and shift of the articular surface. Allograft cancellous bone is the transplant material for the treatment of bone defects, but its osteogenesis ability is poor. Autologous red marrow has osteogenesis ability. Therapeutic efficiency of allograft cancellous bone combined with autologous red marrow for periarticular fractures is still yet to be assessed. OBJECTIVE： To study clinical effect of locking plate fixation and allograft cancellous bone combined with autologous red marrow in the treatment of periarticular fractures. METHODS： Forty-three cases of periarticular fractures were incorporated into the Orthopaedics Department of the Third Hospital of Hebei Medical University. After cutting the articular surface anatomically, composite particles of the red marrow and allograft cancellous bone were implanted into bone defects, and then, an anatomic locking plate was used. Medial lateral or bilateral locking plate was used for tibial plateau fractures. Dorsal or volar locking plate was used for distal radius fractures, and distal tibial medial or lateral locking plate was used for distal tibial fractures. RESULTS AND CONCLUSION： Forty-three patients were followed up for 12 months to 6 years, an average of 4.3 years. X-ray films and CT scans review showed that 43 patients＇ collapse fracture all reached bony union. Fresh fracture healing time was 2-6 months, an average of 4 months; the healing time for old fracture was 37 months, an average of 5.5 months. After bone grafting, 43 patients all had no significant immune rejection, two cases showed more wound exudates, and the wound was healed by dressing after 2 weeks. One case had wound infection, the wound was healed after 4 weeks of draining and dressing, and the infection had no recurrence following up for 4 years and 1 month. Forty patients were
出处
《中国组织工程研究》
CAS
CSCD
2013年第48期8419-8428,共10页
Chinese Journal of Tissue Engineering Research
基金
the Scientific and Technological Research Program of Hebei Provincial Health Bureau,No.20090417~~
